Demystify CMS Program Audit Management
Build orderly universes in the beginning to achieve the biggest bang at the lowest cost
Centralize data to facilitate stronger collaboration and drive regulatory compliance
Review real-time status of all findings, recommendations and corrective action plans
Facilitate efficient collaboration and secure data exchange with outside agencies
Collaborate efficiently with first-tier, downstream and related (FDR) delegated entities
Centralize Secure Audit Data
Improve Collaboration Across Teams
Sustain Continuous Audit Readiness
Integrate External Communications
Manage FDR Compliance
Since the CMS program audit utilizes various universes—such as Part C Organization Determinations, Appeals and Grievances (ODAG), Part D Coverage Determinations, Appeals and Grievances (CDAG) and Medicare-Medicaid Plan Service Authorization Requests, Appeals and Grievances (SARAG)—to evaluate health plan performance, it’s essential for audit and monitoring teams to leverage real-time data. Yet, despite current innovations to address CMS Program Audits, it has been a perpetual challenge for health plans to create and submit accurate, timely universes to avoid invalid data submissions and poor audit scores.
Many healthcare organizations still rely on time-consuming manual program-audit processes, which are often riddled with errors, inconsistencies or both. However, having over 125 years of combined audit and monitoring expertise, Inovaare knows that by automating the process, health plans can be better prepared to generate and validate accurate, clean universes that are ready for submission. As a result, they will improve operational efficiency and achieve a healthier bottom line.
Minimize program audit errors with workflow automation
Efficiently oversee compliance readiness through regular mock audits based on current CMS Program Audit protocols. Merge different workflows and maintain a system-wide overview of all compliance activities. This cloud-based solution empowers healthcare compliance teams to:
Monitor CMS universes proactively
Create a culture of compliance by monitoring your health plan’s processes to improve operational health and create a better member experience. Our Internal Monitoring module, with all federal and state rules and regulations embedded, helps health plans to:
FDR MANAGEMENT FOR END-TO-END CMS PROGRAM AUDIT COMPLIANCE
Systematically conduct audits and perform file reviews of first-tier, downstream and related (FDR) delegated entities to create a culture of compliance within the areas of Credentialing, Utilization Management, Quality Improvement and other delegated functions. This essential software module can:
- Intuitive real-time dashboards and reports for health-plan management, audit committees and stakeholders
- Standardized workflow-driven audit processes that minimize errors
- Optimized audit-process visibility, simplifying risk management and compliance
- Expedited feedback processes to mitigate operational and enterprise risks
- Increased productivity, by facilitating collaboration within your organization
- Tracked findings, recommendations and action plans
Take a lighthearted tour within a fictitious health plan as they fret over a CMS Program Audit . . . until Inovaare’s industry-leading solution saves the day.
UNIVERSE MANAGEMENT OVERVIEW: VIDEO
UNIVERSE MANAGEMENT SYSTEM
Ensure your health plan submits accurate, properly formatted CMS regulatory reports with the touch of a button.
CMS AUDIT BLOG
Are you ready for 2022? Forewarned is Forearmed: Prepare for 2021 CMS Audit Protocol Changes will help.
AUDIT READINESS WEBINAR
Explore how to proactively manage universes in this webinar: Compliance Favors Only the Prepared Plan.
UNIVERSE SCRUBBER OVERVIEW: VIDEO
Discover how Universe Scrubber can revolutionize the audit preparation processes.
Learn how a Fortune 500 health plan serving Medicare and Medicare-Medicaid (MMP) members achieved an 80% reduction in CMS Program Audit data-submission efforts.